“…It is possible that younger adolescents, who were more likely to sustain participation over time, were less able to build self-efficacy without the role-modelling of older adolescents and less equipped to create change without the support of parents and other adults. This is consistent with the conclusions of a systematic review ( Siddiqui et al, 2020 ) as well as smaller qualitative studies conducted in rural India ( Guha et al, 2019 , Sharma et al, 2021 ) that peer education and participatory adolescent groups have been more effective at improving knowledge and attitudes than changing behaviours linked to health outcomes.…”